| NPI | 1659619922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008530) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 019529) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 153870) | |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2022-01-10 |