| NPI | 1871116004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001352) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 832119) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2023-10-12 |