| NPI | 1386223170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11026244) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL RN9432879) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2023-06-30 |