| NPI | 1356411003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3211) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 12593) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2021-12-30 |