| NPI | 1467901884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1027255) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 019842) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2021-01-18 |