| NPI | 1619630134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017154) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1147930) |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2022-02-09 |