| NPI | 1790772721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3003678) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1085782) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-03-01 |