| NPI | 1346982170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61317489) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60768328) |
| 163W00000X Registered Nurse (Licence: GA RN250862) | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2024-02-22 |