| NPI | 1134128739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 052938) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 10616) |
| 163W00000X Registered Nurse (Licence: TN 105486) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2022-03-22 |