| NPI | 1174197784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61201204) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61153392) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 71582) | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2023-09-01 |