| NPI | 1144604695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD R215366) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN75682-CRNA) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2019-07-10 |