| NPI | 1699750661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 104604-030) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 1149-33) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2016-06-13 |