| NPI | 1770107484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61658506) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WA RN60395365) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2900) | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2025-04-01 |