| NPI | 1174710925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 71206) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 561421) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2018-02-08 |