| NPI | 1710973078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN10101) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN RN11946) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2010-05-21 |