| NPI | 1619399821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008986) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 135309) |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2014-10-02 |