| NPI | 1306554050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001912) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95304321) |
| Enumeration Date | 2022-11-11 |
| Last Update Date | 2022-11-23 |