| NPI | 1174683486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN8759) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN35245) |
| 163W00000X Registered Nurse (Licence: GA RN114857) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2010-02-08 |