| NPI | 1740612233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0962) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9311691) |
| 163W00000X Registered Nurse (Licence: AZ RN181446) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2014-02-10 |