| NPI | 1104962216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN11063) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN65030) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-01-20 |