| NPI | 1427504489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN93856-CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 93856) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN637728) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2020-10-09 |