| NPI | 1134149388 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN0000113987) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC Compact rn#113987) | 
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN#11231) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX compact APN#11231) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX compact rn#113987) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APN#2655) | |
| Enumeration Date | 2006-07-20 | 
| Last Update Date | 2022-03-23 |