| NPI | 1871185645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95002306) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95070226) |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2024-04-12 |