| NPI | 1194054403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0772) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV TCRNA800131) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: UT MP4670976) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2018-09-24 |