| NPI | 1770108862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 86211) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 110955) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020098) | |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2023-06-28 |