| NPI | 1558000968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001794) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: CA 95065203) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2026-02-05 |