| NPI | 1720444045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201600396CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201140966RN) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2019-02-05 |