| NPI | 1023521457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60815499) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60792813) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2025-07-14 |