| NPI | 1356183578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002576) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95121943) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2025-07-30 |