| NPI | 1407141443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP123261) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557038) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 14100305061) | |
| 163W00000X Registered Nurse (Licence: KS 14100305061) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2024-03-20 |