| NPI | 1326575655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23243) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95060711) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2017-10-04 |