| NPI | 1770928244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-881A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60332807) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1529) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2021-11-03 |