| NPI | 1245984566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 138682) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 226904-30) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-02-06 |
| Last Update Date | 2022-05-27 |