| NPI | 1376198911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3014181) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 223049) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2020-01-10 |