| NPI | 1972556447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 152532) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2020034592) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-04-03 |