| NPI | 1902275142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60607230) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 212544-6) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2015-10-27 |