| NPI | 1740643840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA R185248) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD R185248) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RN654111) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2023-03-29 |