| NPI | 1114991411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 2844) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 598039) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-01-03 |