| NPI | 1720659915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10027530) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 257188) |
| 163W00000X Registered Nurse (Licence: OR 201340077RN) | |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2024-06-10 |