| NPI | 1770698425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN RN 0000136659) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 046594) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000011851) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |