| NPI | 1912861915 |
|---|---|
| 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: PA RN755435) |
| Enumeration Date | 2025-12-13 |
| Last Update Date | 2026-03-23 |