| NPI | 1255427233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3002035) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN rn0102643) |
| 163W00000X Registered Nurse (Licence: KY 1078602) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 2035-a) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-09-04 |