| NPI | 1538122734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN00136294) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30006644) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2007-07-09 |