| NPI | 1811494933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1506) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 121357) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-20 |