| NPI | 1710234513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 079483-23) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 07948323) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 90198) | |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2025-01-27 |