| NPI | 1679801484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 64303) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 331469) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9492405) | |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2022-09-18 |