| NPI | 1760404248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 054077) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 204727) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-12-16 |