| NPI | 1164846275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000065) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA RN 585430) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2022-02-11 |