| NPI | 1518663855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002556) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95260068) |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2025-04-01 |