| NPI | 1124265871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005916) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1103993) |
| Enumeration Date | 2009-01-17 |
| Last Update Date | 2015-12-02 |