| NPI | 1396934550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN55094) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 55094) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3006379) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2020-12-07 |