| NPI | 1730356981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 13207) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN0000013207) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2010-10-20 |