| NPI | 1013355817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60367548) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WA AP60367548) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2016-08-18 |