| NPI | 1528576089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA Ap61656978) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 117959) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2026-04-03 |