| NPI | 1487905816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 532839) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI 1215) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4296) | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2021-03-17 |