| NPI | 1215679329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 116543) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 93554) |
| 207L00000X Anesthesiology (Licence: WV 116543) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-09 |
| Last Update Date | 2023-06-09 |