| NPI | 1629388145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61109661) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3965) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5933) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2023-01-25 |