| NPI | 1700407145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61077181) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APN.29452) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2025-08-08 |