| NPI | 1184695140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30005759) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN0117713) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-11-23 |