| NPI | 1639576028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0001256424) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024172350) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2015-07-16 |