| NPI | 1174930911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN19104) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000174196) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2020-06-08 |