| NPI | 1144521162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 17525) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000145303) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169159) | |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2018-08-30 |