| NPI | 1568804755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19243) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R880402) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2018-07-17 |