| NPI | 1083295166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202111766CRNA-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201390444RN) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2025-08-13 |