| NPI | 1700933819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 25457) |
| 163WC0400X Registered Nurse, Case Management (Licence: WY 25457) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704229756) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2019-02-26 |