| NPI | 1104203249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 7640423-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95000384) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000384) | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2018-08-15 |