| NPI | 1316427164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3012665) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 183514) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2018-09-09 |