| NPI | 1184990657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4200) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 810337) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2012-03-28 |