| NPI | 1801365291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60914126) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 4881514) |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2026-08-18 |