| NPI | 1316353543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000201) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 754643) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2021-10-08 |