| NPI | 1558795641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 701127) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 200941197RN) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2022-02-04 |