| NPI | 1467025494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6876) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 291583) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 291583) | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2022-10-06 |