| NPI | 1730559352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201800298) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 163W00000X Registered Nurse (Licence: OR 201042896RN) | |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2018-11-26 |