| NPI | 1881155836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001167) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN95178472) |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2019-08-13 |