| NPI | 1215005228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3555) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: CA 576417) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-07-21 |