| NPI | 1609851534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA AP60796420) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 482242, 11412) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2019-11-05 |