| NPI | 1184058570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60404208) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 6445536-4406) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2020-11-04 |