| NPI | 1912076969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30007621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00134315) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-04-29 |