| NPI | 1124308473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-113384) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN16057) |
| 163W00000X Registered Nurse (Licence: TN RN169321) | |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2013-09-16 |