| NPI | 1255571550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60401489) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 5901a) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2022-09-29 |