| NPI | 1316283195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007830) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: KY 1117275) |
| Enumeration Date | 2012-12-23 |
| Last Update Date | 2013-01-18 |