| NPI | 1760786362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 58241) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 351197-4405) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP9572) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1353) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-815A) | |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2022-12-22 |