| NPI | 1376998823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60649399) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA AP60649399) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2016-12-30 |