| NPI | 1467510453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN8749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN34837) |
| 163W00000X Registered Nurse (Licence: GA RN048713) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2010-02-02 |