| NPI | 1396286498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22870) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 887946) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2017-08-09 |