| NPI | 1508825324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 30042432) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV APRN59696-CRNA) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4232A) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2021-12-02 |