| NPI | 1619080280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ crna0700) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP1681) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 062492-23) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2013-02-22 |