| NPI | 1598043572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0786) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN139385) |
| 163W00000X Registered Nurse (Licence: FL RN9307995) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2011-09-16 |