| NPI | 1811387905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60864032) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2015003183) |
| 163W00000X Registered Nurse (Licence: MO 2015001993) | |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2024-12-12 |