| NPI | 1265407134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN11209) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN102072) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN153379) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2008-08-27 |