| 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 |