| NPI | 1467524629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 35460) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 07080) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2011-09-23 |