| NPI | 1720695455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001503) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 723230) |
| Enumeration Date | 2020-09-27 |
| Last Update Date | 2021-02-18 |