| NPI | 1326240367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA3023) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 509823) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2017-05-24 |