| NPI | 1386829950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3015765) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 78185) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2021-04-20 |