| NPI | 1184682627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3006015) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1125674) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2016-03-24 |