| NPI | 1093701369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 54695) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 054753) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2014-06-05 |