| NPI | 1679372288 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN691087) |
| Enumeration Date | 2025-03-08 |
| Last Update Date | 2025-04-08 |