| NPI | 1457962011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001995) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 848209) |
| Enumeration Date | 2020-08-16 |
| Last Update Date | 2023-09-11 |