| NPI | 1699103911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1011) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD CRNA1011) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2021-06-16 |