| NPI | 1568837979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024178081) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 20630) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2025-05-15 |