| NPI | 1861156580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001734) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95026145) |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2022-05-06 |