| NPI | 1205312287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60885868) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27643) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2023-10-03 |