| NPI | 1407445109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024189251) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN692480) |
| 163WE0003X Registered Nurse, Emergency (Licence: PA 0988255) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-16 |
| Last Update Date | 2024-01-29 |