| NPI | 1861878167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60594372) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000485) |
| 163W00000X Registered Nurse (Licence: NV RN64146) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2015-11-25 |