| NPI | 1508240219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01503) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1152) |
| 163W00000X Registered Nurse (Licence: AZ RN152568) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2017-10-24 |