| NPI | 1780555847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 18007) |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2026-04-02 |