| NPI | 1306202429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP131015) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC RN1019944) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2019-04-26 |