| NPI | 1568412096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP300007207) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: WA RN00162696) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-08-21 |