| NPI | 1528505666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4037576) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 181194) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 112907) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23278) | |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2025-04-28 |