| NPI | 1548901739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 113030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001282301) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-09-08 |