| NPI | 1912532466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 106742) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 91915) |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2020-06-25 |