| NPI | 1891912440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA3423) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NPF95014649) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2024-12-04 |