| NPI | 1982211785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95002659) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 246957) |
| 163W00000X Registered Nurse (Licence: PR 099694) | |
| 163W00000X Registered Nurse (Licence: CA 95042984) | |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2025-08-20 |