| NPI | 1053361592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN8760) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 35291) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2010-01-05 |