| NPI | 1689347940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002540) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95051922) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2025-07-10 |