| NPI | 1124124664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN14319) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL RN2961222) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN132292) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2016-12-01 |