| NPI | 1164806709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009690) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1121486) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2016-03-22 |