| NPI | 1700889409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3004228) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 166747) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71001350A) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041315277) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2018-08-22 |