| NPI | 1659850741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 123195) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 213319) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-10-22 |