| NPI | 1740283456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 24307) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT RN24307) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2009-12-23 |