NPI | 1215369566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201600382CRNA) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201240773RN) |
Enumeration Date | 2013-08-08 |
Last Update Date | 2025-09-24 |