| NPI | 1912422049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61037393) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WA RN60286257) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2020-04-12 |