| NPI | 1790267037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24895) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000177219) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2022-03-31 |