| NPI | 1942811773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 240546) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA RN157214) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA RN157214) | |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2025-06-28 |