| NPI | 1134660574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 96642) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AR R098277) |
| Enumeration Date | 2017-03-18 |
| Last Update Date | 2025-08-08 |