| NPI | 1942801162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001530) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 844058) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2022-12-23 |