| NPI | 1669080511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001393) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA Pending) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2021-09-22 |