| NPI | 1952817371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 141262) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 077013-23) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2022-05-18 |