| NPI | 1528856648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 245249) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN152199) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2026-01-15 |