| NPI | 1609543818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 36333) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 23558) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2024-05-29 |