| NPI | 1417449810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60872413) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: WA RN60272088) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-10-19 |