| NPI | 1720635873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001689) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95052605) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2022-03-08 |