| NPI | 1407126212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP6027366) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND R30271) |
| 163W00000X Registered Nurse (Licence: WA RN 60183310) | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2019-04-30 |