| NPI | 1528305109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007849) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1134026) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2016-03-22 |