| NPI | 1326564766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 129045) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60717743) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60782203) | |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2023-12-06 |