| NPI | 1740051622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002570) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95137137) |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2025-03-05 |