| NPI | 1679650402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 075642) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 54493) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-02-03 |