| NPI | 1235474016 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA4345) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4345) | 
| Enumeration Date | 2012-12-04 | 
| Last Update Date | 2022-01-03 |