| NPI | 1700397163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60909561) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 108991) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2019-04-30 |