| NPI | 1285099630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 20749) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 183590) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2018-04-02 |