| NPI | 1164962064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001358) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201701285CRNA) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2021-01-29 |