| NPI | 1114686631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DEWEY CHILDERS Owner/President 415-290-1884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2021-12-13 |