| NPI | 1609953157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 029908) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 138) |
| 163W00000X Registered Nurse (Licence: WI 111617) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2017-04-11 |