| NPI | 1780914432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3006434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1123297) |
| 163W00000X Registered Nurse (Licence: IN 28189826A) | |
| 163W00000X Registered Nurse (Licence: OH RN 256716) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2021-10-05 |