| NPI | 1164859690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000040) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 676787) |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2017-01-13 |