| NPI | 1013534346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10014902) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 201705526RN) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2024-01-09 |