| NPI | 1053347005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN11903) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN115372) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2010-01-25 |