| NPI | 1952738924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 80675) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 101305) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2022-02-28 |