| NPI | 1790725950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200760019CRNA) |
| Additional Taxonomies | 174400000X Specialist |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30007764) | |
| 163W00000X Registered Nurse (Licence: WA RN00173377) | |
| 163W00000X Registered Nurse (Licence: OR 20074175RN) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2015-12-30 |