| NPI | 1407431307 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 079441-23) | 
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NH 079441-21) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-11 | 
| Last Update Date | 2021-06-11 |