| NPI | 1659162295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 152236) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 6772707-3102) |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2025-08-08 |