| NPI | 1114177268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005577) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 5577A) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2012-09-04 |