| NPI | 1821475849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D116603) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA D116603) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2023-11-09 |