| NPI | 1154328326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000009544) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 80283) |
| 163W00000X Registered Nurse (Licence: TN RN0000080283) | |
| Enumeration Date | 2005-07-03 |
| Last Update Date | 2022-07-07 |