| NPI | 1487630091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 037860) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1054975) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2008-04-20 |