| NPI | 1538132964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN20149) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN511838L) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2022-03-31 |