| NPI | 1629053095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 37861) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1042047) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2011-06-30 |