| NPI | 1528890100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61599708) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: WA RN61554522) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2025-02-17 |