| NPI | 1649314204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2011004383) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 139645) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2022-07-21 |