| NPI | 1821567082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6061) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 309920) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 163W00000X Registered Nurse (Licence: AK 119624) | |
| 163W00000X Registered Nurse (Licence: TN 198121) | |
| Enumeration Date | 2018-11-17 |
| Last Update Date | 2023-11-09 |