| NPI | 1609876416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3001954) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1059868) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2015-10-23 |