| NPI | 1487753364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN0000039771) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 1203497) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: TN RN0000039771) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-08-22 |