| NPI | 1407370208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60790431) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60134070) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2021-04-29 |