| NPI | 1083973499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4268) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 625335) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2016-09-07 |