| NPI | 1528466083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19589) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 163596) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2015-02-05 |