| NPI | 1306427380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 135172) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60455959) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-06-05 |