NPI | 1063058220 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP144768) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX pending) |
Enumeration Date | 2019-11-22 |
Last Update Date | 2021-12-16 |