| NPI | 1114980794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 328977) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30004706) |
| 163W00000X Registered Nurse (Licence: WA RN00130544) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2025-09-10 |