| NPI | 1336219831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95146735) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: OR 200642513RN) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2019-08-27 |