| NPI | 1881999092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60209076) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 799698) |
| 163W00000X Registered Nurse (Licence: WA RN00125453) | |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2020-12-04 |