| NPI | 1154421956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA2913) |
| Additional Taxonomies | 372500000X Chore Provider (Licence: CA CRNA2913) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-10-01 |