| NPI | 1831831957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 116716) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-09 |
| Last Update Date | 2023-12-12 |