| NPI | 1720862675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1171102) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2871) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2024-11-08 |