| NPI | 1083289623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3016589) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1147177) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-08-31 |