| NPI | 1326595034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1242) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN150884) |
| Enumeration Date | 2016-09-10 |
| Last Update Date | 2016-09-26 |