| NPI | 1023360260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 17054) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 190871) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2013-04-10 |