| NPI | 1710326426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60373802) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WA AP60373802) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2018-06-18 |