| NPI | 1043798598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95001122) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 124698) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2023-08-01 |