| NPI | 1114099231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 50941) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 08139) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2011-09-23 |