| NPI | 1962072066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11017760) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL RN9391884) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2025-03-14 |