| NPI | 1164911319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3012374) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1157363) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2018-06-08 |