| NPI | 1871127449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 006957) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 163W00000X Registered Nurse (Licence: NC 283634) | |
| Enumeration Date | 2020-02-23 |
| Last Update Date | 2022-09-29 |