| NPI | 1720693054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001468) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95035493) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2025-04-06 |