| NPI | 1407414352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3014022) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 195106) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2019-11-05 |