| NPI | 1245490820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 082580) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 583590) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2017-12-21 |