| NPI | 1649388372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000010706) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000084386) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 045081) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-06-25 |