| NPI | 1518935931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP3000985) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2025-05-09 |