| NPI | 1700830544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN 10544) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN 147039) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2011-06-09 |