| NPI | 1336504208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009983) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 161179) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-30 |