| NPI | 1245415397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 079098) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1090399) |
| 163W00000X Registered Nurse (Licence: OH 262060) | |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-07-31 |