| NPI | 1649643412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000498) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95035744) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95035744) | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2016-03-14 |