| NPI | 1629747209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 279708) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28256185A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 28256185A) | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2025-10-01 |