| NPI | 1023194560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA3600) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR L000447CRNA) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-03-18 |