| NPI | 1427054089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 989) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA rn178935) |
| 363L00000X Nurse Practitioner (Licence: NC 5015807) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2023-11-21 |