| NPI | 1235502030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0993908-CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN623456) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00735700) | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2019-11-21 |