| NPI | 1831421759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 674062) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3958) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2021-12-27 |