| NPI | 1902295124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60537173) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19511) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2025-09-25 |