| NPI | 1407507056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61267515) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 139454) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-02-23 |