| NPI | 1902475197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 243663-30) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN R209466-1) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2023-02-15 |