| NPI | 1881257962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 104105) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 89471) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-09-04 |