| NPI | 1982042503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201360034CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 110789) |
| 163W00000X Registered Nurse (Licence: OR 201341149rn) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2022-02-04 |