| NPI | 1629526918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22211) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 188913) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2017-01-24 |