| NPI | 1609295773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000206) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 745474) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-04-21 |