| NPI | 1184878720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1142) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 098745) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2015-09-03 |