| NPI | 1538997002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002736) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95065784) |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2025-10-30 |