| NPI | 1952399545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 006930) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1103273) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000010406) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 07240) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 054720) | |
| Enumeration Date | 2005-10-09 |
| Last Update Date | 2021-06-04 |