| NPI | 1639160674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 036799) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1041947) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2012-08-28 |