| NPI | 1053806786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60790046) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA 60790046) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2019-09-03 |