| NPI | 1104841618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN 559664) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA 2547) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2025-09-11 |