| NPI | 1649242579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201702031CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA RN00128990) |
| Enumeration Date | 2006-02-04 |
| Last Update Date | 2021-09-17 |