| NPI | 1528798568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024190273) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: WV 97080) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-07-09 |