| NPI | 1083869853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60466104) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 153838-30) |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2016-06-08 |