| NPI | 1700054277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008033) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1135570) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2016-03-23 |