| NPI | 1972106375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001507) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 803722) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2021-02-24 |