| NPI | 1619479797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R217862) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 768650) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000925) | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2019-03-05 |