| NPI | 1740691096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1052) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN187379) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2020-05-08 |