| NPI | 1063868479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202004533) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 60656552) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2020-06-09 |