| NPI | 1629052436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0564) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN3150502) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD r168347) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2019-09-23 |