| NPI | 1639534316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 6473) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN95248512) |
| 163W00000X Registered Nurse (Licence: CT 072732) | |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: CT 72732) | |
| 207L00000X Anesthesiology (Licence: CA NA95001548) | |
| 363L00000X Nurse Practitioner (Licence: CT 6473) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95001548) | |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2022-02-01 |