| NPI | 1255038444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 34659) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704339812) |
| 163W00000X Registered Nurse (Licence: TN 241120) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704339812) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2023-09-15 |