| NPI | 1801308671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1481) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 171273) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK M134182) | |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2019-08-22 |