| NPI | 1992355655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001204) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 800839) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2019-10-15 |