| NPI | 1669865382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000322) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 708797) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2023-10-03 |