| NPI | 1093308330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 109968) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 85982) |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2021-07-15 |