| NPI | 1235648916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01530) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8000945-3102) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2020-02-04 |