| NPI | 1780011866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 92790) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RN631383) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2013-12-16 |