| NPI | 1982902367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT NUR-APRN-LIC-165777) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 728283) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2021-11-11 |