| NPI | 1164965893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000677) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 753803) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2025-01-23 |