| NPI | 1497930432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201160021CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R63115) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0647) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2011-12-21 |