| NPI | 1841696507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R869480) |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2015-02-03 |