| NPI | 1043383375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 104762) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 104762) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 11185) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 5249A) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2011-01-26 |