| NPI | 1629142351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA1033) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 1033) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2016-11-03 |