| NPI | 1144424144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3530) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 17255) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2019-02-20 |