| NPI | 1861485021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30004926) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00083645) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-919A) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2020-12-11 |