| NPI | 1609220680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 749425) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 229948) |
| 163W00000X Registered Nurse (Licence: FL RN9369601) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 111566) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2021-10-28 |