| NPI | 1467152942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11039869) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD R241264) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2025-08-04 |