| NPI | 1306572904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001889) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95124461) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2023-03-08 |