| NPI | 1376980946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1054) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2013008776) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2016-09-22 |