| NPI | 1376717587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN 13474) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN 100682) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2025-01-07 |