| NPI | 1821535972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60730485) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60720482) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2017-03-13 |