| NPI | 1225659634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61079172) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 241219-30) |
| 163W00000X Registered Nurse (Licence: WA RN61063905) | |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2022-02-17 |