| NPI | 1932192804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3005250) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 5250A) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN0000139182) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2022-10-05 |