| NPI | 1730468042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN15984) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN153449) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2022-07-28 |