| NPI | 1740375526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60110772) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 543521) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-04-30 |