| NPI | 1043967565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 220430) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AR R101732) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2022-06-16 |