| NPI | 1013955368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP2127012) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 033120) |
| 163W00000X Registered Nurse (Licence: KY 1044987) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2008-06-03 |