| NPI | 1639653165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24252) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 24252) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 24252) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2026-03-07 |