| NPI | 1174128581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1132264) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 1132264) |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2022-10-10 |