| NPI | 1215230396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3006797) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1108651) |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2020-05-19 |