| NPI | 1588028310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP08879) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA RN139455) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2016-11-04 |