| NPI | 1689641094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3010528) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 509832) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2016-09-09 |