| NPI | 1609029107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 081074) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1104576) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2009-07-22 |