| NPI | 1639410608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN17616) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 92445) |
| 163W00000X Registered Nurse (Licence: FL 9312515) | |
| 163W00000X Registered Nurse (Licence: TN 133506) | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2013-09-23 |