| NPI | 1871397422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 84604) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0128863) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2025-08-27 |