| NPI | 1255853495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60782874) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 60649007) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2023-01-05 |