| NPI | 1639256001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN19965) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 900) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-01-31 |