| NPI | 1902473978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 134990) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KY 1144597) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 00000000) | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2021-08-18 |