| NPI | 1205237955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 677299) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 677299) |
| 163W00000X Registered Nurse (Licence: CA 95000168) | |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2024-02-15 |