| NPI | 1013167501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0701) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 571600) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2020-10-02 |