| NPI | 1417360447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 18823) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 161308) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2017-12-05 |