| NPI | 1215015706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN9933) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02690) |
| 163W00000X Registered Nurse (Licence: TN RN99854) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-08-05 |