| NPI | 1407094634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005875) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 5875A) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2018-10-19 |