| NPI | 1760982631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60825535) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60825533) |
| Enumeration Date | 2018-02-17 |
| Last Update Date | 2018-04-09 |