| NPI | 1679916670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5369390-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0932) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2016-12-01 |