| NPI | 1629024765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 094006391CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00081581) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30005028) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-10-20 |