| NPI | 1649881129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI RN152263) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 230450) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA RN152263) | |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2025-03-27 |