| NPI | 1639704828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 138480) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 278024) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-08 |
| Last Update Date | 2025-07-08 |