| NPI | 1972145332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3014267) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.434049) |
| 163W00000X Registered Nurse (Licence: KY 1140229) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2020-01-28 |