| NPI | 1770502213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS 902973) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R801579) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-12-11 |