| NPI | 1962486829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0992028-CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 21451) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0841) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2020-01-29 |