| NPI | 1194794040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN 121155) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007097) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC RN 121155) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-03-17 |