| NPI | 1639154685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 023081) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1028649) |
| 163W00000X Registered Nurse (Licence: OH 154045) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH NA00804) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2016-09-16 |