| NPI | 1104466259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61393537) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN721483) |
| 207L00000X Anesthesiology (Licence: WA AP61393537) | |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2025-05-19 |