| NPI | 1568438232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN082426) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN09588) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN122489) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2010-06-30 |