| NPI | 1902209067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4014541) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 69018) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2024-01-05 |