| NPI | 1215351713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60513460) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001225951) |
| 163W00000X Registered Nurse (Licence: AZ RN184109) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1010) | |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2015-10-30 |