| NPI | 1417595661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 111944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN679858) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2023-02-22 |