| NPI | 1154138170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 205658) |
| 163WN0800X Registered Nurse, Neuroscience (Licence: LA 205658) | |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2026-06-17 |