| 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 |