| NPI | 1376189746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202103971CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR RN676683) |
| 163W00000X Registered Nurse (Licence: PA RN676683) | |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2021-05-11 |