| NPI | 1053771063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60633486) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201604055CRNA-PP) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2022-05-23 |