| NPI | 1295479368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN95413616) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95002593) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2025-10-01 |