| NPI | 1154949055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 837617) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11009755) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 074744) | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2023-10-17 |