| NPI | 1902280068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ crna1171) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R34868) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2017-03-24 |