| NPI | 1568612588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 14427) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2013043635) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 153803) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007109) | |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2021-06-11 |