| NPI | 1124021019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0766) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN170834) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 167341) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 55314) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2019-07-01 |