| NPI | 1356643589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201360012CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201040687RN) |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2026-02-19 |