| NPI | 1457594152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 14435) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 140626) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2019-10-09 |