| NPI | 1073910378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009244) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1116491) |
| 163W00000X Registered Nurse (Licence: IN 28214626) | |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2016-02-02 |