| NPI | 1366996605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 21914) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 168237) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-11-17 |