| NPI | 1184688749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3004468) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 08204) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN356726L) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 3291412) | |
| 163W00000X Registered Nurse (Licence: KY 1105174) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2024-04-29 |