| NPI | 1558349977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000317) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA crna225) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2011-02-08 |