| NPI | 1164822920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1070) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 256689) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2018-09-24 |