| NPI | 1548505621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA4359) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 825943) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2017-05-24 |