| NPI | 1790721876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 51127) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 5986A) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 9088) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2011-01-11 |