| NPI | 1043284409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN87587) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN516921L) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-11-05 |