| NPI | 1154870301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000630) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 781152) |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2021-10-11 |