| NPI | 1255843108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23753) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 208647) |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2018-01-29 |