| NPI | 1689019929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22072) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024171086) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MS A810705) | |
| 163W00000X Registered Nurse (Licence: TN 163517) | |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2017-02-23 |