| NPI | 1083802995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0642) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 626276) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2019-04-19 |