| NPI | 1710364963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60559824) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60127658) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-04-01 |