| NPI | 1679545099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0261) |
| Additional Taxonomies | 163WX1100X Registered Nurse, Ophthalmic (Licence: AZ 053540) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2018-05-15 |