| NPI | 1649208810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3002546) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 2546A) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-07-11 |