| NPI | 1528612512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN26572) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 181424) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2019-09-26 |