| NPI | 1861545824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60192189) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ RN119889) |
| 163W00000X Registered Nurse (Licence: WA RN60182465) | |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2014-10-20 |