| NPI | 1144740374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61104694) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9315958) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA AP61104694) | |
| 363L00000X Nurse Practitioner (Licence: FL 9315958) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-11-01 |