| NPI | 1689660169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005255) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 050588) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2021-04-20 |