| NPI | 1508136193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA4207) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000170152) |
| 163W00000X Registered Nurse (Licence: CA 653748) | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2017-10-05 |