| NPI | 1417356130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1069) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN186114) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2014-10-24 |