| NPI | 1821758202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61257123) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60701046) |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2022-04-28 |