| NPI | 1144636937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000180) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 731931) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2021-10-24 |