| NPI | 1316257736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3006761) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1108550) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2020-04-20 |