| NPI | 1336187806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN00118886) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WA RN00118886) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30005061) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200460027CRNA) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2018-12-19 |