| NPI | 1780286344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 64039) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1029382) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2021-09-02 |