| NPI | 1306120779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA4391) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 22570531) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2015-09-10 |