| NPI | 1235719105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001575) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001285481) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-09-07 |