| NPI | 1467752089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9262454) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9262454) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD AC002401) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC002402) | |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2024-01-26 |