| NPI | 1306978820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KY 1068708) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 192147-4406) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1588A) | |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2007-07-08 |