| NPI | 1558795641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201901595CRNA-PP) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA 701127) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2025-09-23 |