| NPI | 1639655020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 0000024814) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000172873) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2019-02-21 |