| NPI | 1528746682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 325844) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ RN176808) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2025-06-23 |