| NPI | 1811294002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN557076) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60896890) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2019-10-18 |