| NPI | 1407963663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN12514) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN144680) |
| 163W00000X Registered Nurse (Licence: GA RN154653) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2017-10-03 |