| NPI | 1508323635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002102) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 95112800) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2024-09-17 |