| NPI | 1861669384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61352661) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 146800) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2022-11-08 |