| NPI | 1083218606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61130551) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA RN60283008) |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2021-07-12 |