| NPI | 1255430732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WV 52415) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 70070) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-08 |