| NPI | 1700965118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 21215) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT apn21215) |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2017-01-10 |