| NPI | 1740727221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60732499) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60182254) |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2023-09-13 |