| NPI | 1316943186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0228) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ RN096694) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2021-09-27 |