| NPI | 1669420568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61054516) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61053308) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-05-22 |