| NPI | 1083918585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4005) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: CA 18560) |
| Enumeration Date | 2010-12-27 |
| Last Update Date | 2021-12-30 |