| NPI | 1124026240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 162214) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-03-29 |