| NPI | 1114036357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3004822) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12677) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-08-09 |