| NPI | 1508256447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3010120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000169631) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 103483) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2020-07-08 |