| NPI | 1770211906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 210236) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 207L00000X) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2022-10-31 |