| NPI | 1174936058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000021380) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA NCO-000002) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017372) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9264208) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2022-02-01 |