| NPI | 1790146108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1205) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.336968) |
| 163W00000X Registered Nurse (Licence: UT 9024533-3102) | |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2020-06-03 |