| NPI | 1477358398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 2671674) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 1-142092) |
| 163W00000X Registered Nurse (Licence: AL 1-142092) | |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2025-11-10 |