| NPI | 1235337833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 99721) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12756) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2012-09-27 |