| NPI | 1588117824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22215) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 1M4986) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2017-02-13 |