| 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) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2016-02-01 |