| NPI | 1942680764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 688715) |
| Enumeration Date | 2015-06-06 |
| Last Update Date | 2015-07-20 |