| NPI | 1902697287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95002621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95114273) |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2025-06-18 |