| NPI | 1013642933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002760) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95132130) |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2025-12-03 |