| NPI | 1255900064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28272918A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN726958) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4000410) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RN726958) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2023-06-06 |