| NPI | 1881136430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60719279) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WA RN60049028) |
| 163W00000X Registered Nurse (Licence: CA 844809) | |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2017-01-03 |