| NPI | 1033622477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23694) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN RN0000197608) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3012017) | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2020-04-21 |