| NPI | 1063480275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA CRNA2646) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA RN568591) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2013-01-17 |