| NPI | 1811435654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000620) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 721329) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2022-01-03 |