| NPI | 1700466570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001555) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95233654) |
| 163W00000X Registered Nurse (Licence: TN 206840) | |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2021-06-16 |