| NPI | 1245206572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN AANA038996) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN53103) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2020-02-10 |