| NPI | 1255919213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 135205) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 000000000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2021-06-05 |