| NPI | 1790117356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 77620) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 90749) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2019-01-29 |