| NPI | 1750630422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 681032) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4283) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2021-11-29 |