| NPI | 1316292477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN64260) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 88050) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2022-08-08 |