| NPI | 1619397502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1038) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN184932) |
| 207L00000X Anesthesiology (Licence: AZ RN184932) | |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2020-10-01 |