| NPI | 1841082104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP70012169) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN70001266) |
| 163W00000X Registered Nurse (Licence: TX 984734) | |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-07-24 |