| NPI | 1134233729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN 9282) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN 63803) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 168219) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2019-05-08 |