| NPI | 1609222561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000514) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 754952) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2017-01-19 |