| NPI | 1093004319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3006933) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000015374) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000015374) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2014-07-10 |