| NPI | 1235808916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001954) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000242402) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2026-01-13 |