| NPI | 1992109698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60517542) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041406451) |
| 163W00000X Registered Nurse (Licence: WA RN60066998) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2018-05-15 |