| NPI | 1972934719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA CRNA95000308) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-107906) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2015-09-14 |