| NPI | 1093853400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30006458) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00148522) |
| 363L00000X Nurse Practitioner (Licence: WA AP30006458) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-07-15 |