| NPI | 1417143546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005411) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 45019) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2021-12-10 |