| NPI | 1568805919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 1327) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 70797) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2024-09-27 |