| NPI | 1053680157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201402450CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN167051) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 88013) | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2020-02-07 |