| NPI | 1417387804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60451841) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 163W00000X Registered Nurse (Licence: WA 60297815) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2025-09-16 |