| NPI | 1700284593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024172271) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 78421) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2024-03-25 |