| NPI | 1578084281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 122391) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 122391) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2023-02-08 |