| NPI | 1164122792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA ARNP.AP.70143182) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 5271264) |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2026-06-17 |