| NPI | 1366671026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 071219) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 004146) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2018-03-17 |