| NPI | 1881263788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1129063) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TX 931257) |
| 171000000X Military Health Care Provider | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-04-01 |