| NPI | 1750258497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP70139840) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1666507) |
| Enumeration Date | 2025-10-18 |
| Last Update Date | 2026-10-02 |