| NPI | 1225071517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 32300) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 243259) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-05-24 |