| NPI | 1417354499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009569) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 89865) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.19104) | |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2025-01-22 |