| NPI | 1063787836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60499120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201142666RN) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2022-04-01 |