| NPI | 1861731879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60338800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60326140) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2023-06-13 |