| NPI | 1164517090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01219) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN12234) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN116970) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-09-14 |