| NPI | 1588435432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 302859) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002837) |
| 163W00000X Registered Nurse (Licence: CA 95357559) | |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2026-03-24 |