| NPI | 1245314764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WV 53976) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 50867) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-09-11 |