| NPI | 1235651951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0993532) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 811937) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2017-12-05 |