| NPI | 1053542209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN14341) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN137996) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2010-09-17 |