| NPI | 1578133567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 111552) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 91395) |
| 163W00000X Registered Nurse (Licence: OH 464912) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-11-08 |