| NPI | 1730177494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0631) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 03435481) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ R49230NM) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00781) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2011-01-25 |