| NPI | 1639711179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024196108) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95001613) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 163W00000X Registered Nurse (Licence: NC 299063) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0001878) | |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2026-01-23 |