| NPI | 1093707945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000009329) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000067803) |
| 163W00000X Registered Nurse (Licence: TN RN0000057803) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2020-05-21 |