| NPI | 1194113902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009152) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-099272) |
| 163W00000X Registered Nurse (Licence: KY 1142230) | |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2015-02-03 |