| NPI | 1780975664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60308924) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID N42071) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2019-01-31 |