| NPI | 1184138794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 119069) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 185646) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2018-02-08 |