| NPI | 1609265065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 074985-23) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 281215) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9178468) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 2017019797) | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2020-05-17 |