| NPI | 1215366117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1004) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN183298) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2020-10-01 |