| NPI | 1447494356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7507) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 3885) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 3885) | |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2024-10-14 |