| NPI | 1487701652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D126589) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA d126589) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 076713) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2023-04-20 |