| NPI | 1649588864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN15235) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN154737) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2010-10-22 |