| NPI | 1164911129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24765) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 880115) |
| Enumeration Date | 2018-05-05 |
| Last Update Date | 2018-09-24 |