| NPI | 1861075418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 66205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1045301) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 136546) | |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2022-01-04 |