| NPI | 1568014561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002812) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95011637) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2026-02-03 |