| NPI | 1790332690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 2001843) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95160452) |
| Enumeration Date | 2019-08-25 |
| Last Update Date | 2022-05-31 |