| NPI | 1033483466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 58763) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 313939) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |