| NPI | 1720407752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60451158) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003258) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2018-09-19 |