| NPI | 1104571140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 139708) |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2022-07-27 |