| NPI | 1942646344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1002) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9317380) |
| 163W00000X Registered Nurse (Licence: UT 6211950-3102) | |
| 163W00000X Registered Nurse (Licence: AZ RN193674) | |
| 163W00000X Registered Nurse (Licence: AZ MSL6211950-3102UT) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2016-09-06 |