| NPI | 1770814394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI APRN-2216) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN162381) |
| 376K00000X Nurse's Aide (Licence: AZ CNA1000010562) | |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2023-11-13 |