| NPI | 1154919710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3015742) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9331626) |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2021-02-08 |