| NPI | 1417377409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 105556) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 76805) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2023-08-09 |