| NPI | 1649419086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA4061) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 566138) |
| 163W00000X Registered Nurse (Licence: VA 0001210184) | |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2015-05-22 |