| NPI | 1164987582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 59265) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN101904) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2020-09-11 |