| NPI | 1942507082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60740468) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 064021-23) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2021-06-16 |