| NPI | 1528489184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008454) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1121654) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2022-09-14 |