| NPI | 1457982159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1048703) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6879) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-01-31 |
| Last Update Date | 2022-07-21 |