| NPI | 1003516659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 007844) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: GA RN291818) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA RN291818) | |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2025-05-14 |