| NPI | 1609812429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN228688) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 373) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-07-08 |