| NPI | 1366078594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 225979) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA RN156512) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2022-08-11 |