| NPI | 1871286708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704287980) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2025-09-16 |