| NPI | 1053964049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 106249) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 287682) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020381) | |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2023-06-06 |