| NPI | 1750999025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024179744) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0024179744) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2020-07-22 |