| NPI | 1699268276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 61161) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8498-33) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2019-06-18 |