| NPI | 1508246976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60562582) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60533594) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2017-02-28 |