| NPI | 1992109748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000271) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 767895) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2015-11-30 |