| NPI | 1053392647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN10063) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN108491) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2010-08-04 |