| NPI | 1295305951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001979) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1017832) |
| 163W00000X Registered Nurse (Licence: AZ 251180) | |
| 163W00000X Registered Nurse (Licence: CA 95049350) | |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2023-03-08 |