| NPI | 1013126457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ID N-28966) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00066178) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA440) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30006256) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |