| NPI | 1508850223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3000948) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 948A) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2021-03-04 |