| NPI | 1568980472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000796) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 849532) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2019-07-05 |