| NPI | 1235793134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 86131) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 103459) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2023-08-04 |