| NPI | 1639144652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3003892) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN52085-CRNA) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-12-31 |