| NPI | 1154829992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60842975) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60825692) |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2018-09-04 |