| NPI | 1457717902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 719120) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000463) | |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2022-08-11 |