| NPI | 1740255645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN11072) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN96791) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN140939) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2014-10-06 |