| NPI | 1801633862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002413) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95096092) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-07-14 |