| NPI | 1124389903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202000056CRNA-PP) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201603754CRNA) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024170109) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2021-07-08 |