| NPI | 1043597453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60528553) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 00142978) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2015-09-28 |