| NPI | 1265801732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201800773CRNA-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201243141RN) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2018-03-17 |