| NPI | 1073918314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 169332) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2015-01-12 |