| NPI | 1295241495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000023733) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 172682) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3012457) | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2022-01-04 |