| NPI | 1366520678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 70063) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 57560) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-07-24 |