| NPI | 1760889828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 92209) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 22671008) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 508962L) | |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2023-10-30 |