| NPI | 1508298258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN17887) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN181080) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-09-10 |