| NPI | 1104984566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60415098) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3251) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200960022CRNA) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2014-06-18 |