| NPI | 1114164035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005900) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 47061) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.019954) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2023-12-06 |