| NPI | 1730675786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA RN720012) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 118636) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2023-11-16 |