| NPI | 1548369929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 290824) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 54873) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 70139) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-03-17 |