| NPI | 1295236388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000907) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 795907) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 121027) | |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-09-26 |