| NPI | 1477601110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA RN354772) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA CRNA2148) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |