| NPI | 1811441975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000666) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 731704) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP09500) | |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2021-01-27 |