| NPI | 1780062604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL APRN9359305) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL APRN9359305) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9359305) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2022-08-24 |