| NPI | 1528184389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3012622) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200660001CRNA) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2018-08-29 |