| NPI | 1730560335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 20307) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000174616) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2020-08-07 |