| NPI | 1720275183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200960006CRNA) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 200040854RN) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2012-05-10 |