| NPI | 1780092353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN19110) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN148984) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2016-06-01 |