| NPI | 1548537780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA4107) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN686164) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2013-01-22 |