| NPI | 1659517852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4036) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OR 200842265RN) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 200842265RN) | |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2022-01-03 |