| NPI | 1043293277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1239A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1061711) |
| 163W00000X Registered Nurse (Licence: TN RN0000047222) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000008996) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2018-03-17 |