| NPI | 1285792739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3003289) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3289A) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2012-03-28 |