| NPI | 1982119913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3011952) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000182538) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2020-06-16 |