| NPI | 1992190284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1134) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC MSL257722NC) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-01-15 |