| NPI | 1700549045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3018272) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 1138437) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2023-02-02 |