| NPI | 1588139166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9426020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ARNP-9426020) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2022-12-29 |