| NPI | 1801180419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202001752CRNA-PP) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 31804) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2022-05-03 |