| NPI | 1134286339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 72161) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 491206-1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 275043) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2020-12-08 |