| NPI | 1174054530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN78336-CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 78336) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-02-29 |