| NPI | 1003239336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000155) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 795016) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-10-13 |