| NPI | 1942601133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1085) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN148792) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2017-01-27 |