| NPI | 1104476977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 0000026641) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 171605) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2019-11-11 |