| NPI | 1659365658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 47452) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28152575A) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2014-11-15 |