| NPI | 1922036565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3004119) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71002125A) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-04-25 |