| NPI | 1700861754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 038782) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1046478) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2021-11-01 |