| NPI | 1043833759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3014646) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 91957) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2021-12-27 |