| NPI | 1508802638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12402) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000135304) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000012402) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2014-04-28 |