| NPI | 1487010997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000510) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 599579-1) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2022-02-11 |