| NPI | 1700144961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0943) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN179341) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000479) | |
| 163W00000X Registered Nurse (Licence: NV RN84000) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2015-07-24 |