| NPI | 1639541196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60931413) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000351) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2021-04-26 |