| NPI | 1568895845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201600750CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200941580RN) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2016-02-24 |