| NPI | 1689641011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3003784) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1098104) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2012-09-17 |