| NPI | 1346846425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1145393) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 3015739) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2021-08-09 |