| NPI | 1952813297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60894656) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-140939-062) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2021-08-03 |