| NPI | 1053603993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 100093) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM crna-01147) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 250160) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2021-03-11 |