| NPI | 1801446497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 171250) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 29868) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2025-05-27 |