| NPI | 1730718826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC006482) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26207) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-01-31 |