| NPI | 1598270282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24371) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R099909) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2018-07-30 |