| NPI | 1750315529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 2251) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 308421) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-09-05 |