| NPI | 1578821468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP 60288624) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00122408) |
| 363L00000X Nurse Practitioner (Licence: WA AP 60288624) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2012-06-11 |