| NPI | 1679767701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA 2443) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 489118) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2013-10-23 |