| NPI | 1679572184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3001929) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1062723) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2015-11-30 |