| NPI | 1457769978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN19125T) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 186662) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28181730A) | |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2015-01-13 |