| NPI | 1972381986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PR 95629) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 95629) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 95629) | |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2024-12-04 |