| NPI | 1104466259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA AP61393537) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN721483) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2023-03-02 |