| NPI | 1811947708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-428) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID RNA428) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1557) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-06-25 |