| NPI | 1710648704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017816) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1153607) |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2022-05-31 |