| NPI | 1205145091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002823) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN R180761) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02823CRNA) | |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2021-12-02 |