| NPI | 1578200580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 112703) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 85894) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-05-19 |