| NPI | 1558796037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 86397) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27085) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2023-03-06 |