| NPI | 1164718037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009939) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 182374) |
| 163W00000X Registered Nurse (Licence: KY 1146687) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2015-12-10 |