| NPI | 1235673062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000659) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 837202) |
| 163W00000X Registered Nurse (Licence: AL 1-133132) | |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2022-01-27 |