| NPI | 1578553418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30005612) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 092006540CRNA) |
| Enumeration Date | 2005-10-23 |
| Last Update Date | 2010-10-20 |