| NPI | 1205258399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008561) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041390031) |
| 163W00000X Registered Nurse (Licence: MO 2011001948) | |
| 163W00000X Registered Nurse (Licence: KY 1139036) | |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2014-03-05 |