| NPI | 1649706052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5671) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 85106) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-09-10 |