| NPI | 1730473612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 085355) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 66172) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2024-03-14 |