| NPI | 1649237991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 028218) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 136201) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2008-05-01 |