| NPI | 1154728343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009185) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28179561A) |
| 163W00000X Registered Nurse (Licence: KY 1133059) | |
| 163W00000X Registered Nurse (Licence: OH 378763) | |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2015-02-03 |