| NPI | 1669930830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201904920CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201042973RN) |
| 163W00000X Registered Nurse (Licence: WA RN60633738) | |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2019-12-13 |