| NPI | 1255465225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 10092) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000110589) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2019-07-17 |