| NPI | 1780205237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61059147) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60261529) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2021-02-19 |