| NPI | 1811999642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA00868) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0061) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP108435) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA1771) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2022-01-19 |