| NPI | 1154138295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4044993) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1123788) |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2025-08-14 |