| NPI | 1043649809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008449) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 155950) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2017-01-27 |