| NPI | 1275798894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 13729) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 141755) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2016-05-18 |