| NPI | 1770927956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3008420) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000161355) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2014-08-27 |