| NPI | 1972862779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0991504) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR RN#R79369) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CRNA#CTP-00203) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2017-04-28 |